General surgery and pathology for dentists . he part. When the fracture occurs in a limbthe displacement of the fragments often produces shortening. 5. Preternatural mobility. 6. Crepitus is a grating sensation detected by the surgeongently moving the fragments against one another. Diagnosis of Fracture. The only sure sign of fracture is preternatural mobility,but it is not always present, ^ in impacted fracture. Eachof the other signs may be at times absent, or whenpresent, may be due to some other cause, thus pain,sensation of snapping and inability to use the injuredpart, may be due to
General surgery and pathology for dentists . he part. When the fracture occurs in a limbthe displacement of the fragments often produces shortening. 5. Preternatural mobility. 6. Crepitus is a grating sensation detected by the surgeongently moving the fragments against one another. Diagnosis of Fracture. The only sure sign of fracture is preternatural mobility,but it is not always present, ^ in impacted fracture. Eachof the other signs may be at times absent, or whenpresent, may be due to some other cause, thus pain,sensation of snapping and inability to use the injuredpart, may be due to damage of muscles or ligaments ;deformity may be due to dislocation ; and crepitus PATHOLOGY AND SUKGERY. 57 may be detected in joint disease, extravasation of blood or airinto the subcutaneous tissues, and in inflammation of thesheaths of tendons. The Union of Fractures. The union of a simple fracture is essentially the same pro-cess as the healing of a wound by first intention. Theimmediate result of the fracture is extravasation of blood. A. Fig. 7. Diagrammatic sketch of repair of simple or Ensheathing Callus. B. Permanent or Definite Internal Callus. around the broken ends ; this gets gradually absorbed, andtakes no part in the healing process. Very soon after theinjury traumatic inflammation supervenes, and plastic lymphexudes from the inflamed bone, medulla, periosteum andneighbouring tissues. The lymph, becoming vascular, formsa mass of granulation tissue surrounding the broken ends of F 58 PATHOLOGY AND SURGERY. the bone, and is known as callus. That portion of it outsidethe broken ends is called external or ensheathing callus, thatinside the medullary cavity internal callus, and that actuallybetween the broken ends permanent or definitive callus. Theinternal and external callus is ultimately absorbed, and istherefore often called temporary, (see Fig. 7.) The callusbecomes converted into fibrous tissue. The outer layer of theensheathing call
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